20192020

2019?2020

BENEFITS ENROLLMENT

Open Enrollment begins February 18, 2019. This is your annual opportunity to choose the benefits coverage that's right for you and your family.

You will have until March 1, 2019 to elect coverage, so now is the time to review your current benefits, check out the available benefits, and make the right choices during Open Enrollment. Your participation is required. Medical insurance will not automatically carry over. You must actively reelect coverage to remain on the plan. This summary is a tool to help guide you through Brock's competitive and comprehensive offerings, including medical, dental, vision, the 401(k) plan, life and accidental death and dismemberment (AD&D), disability, and voluntary benefits (including a new legal option and identity theft option).

Looking for more information?

Using your computer, smartphone, or tablet, you can access your benefits information at .

2019?2020 Benefits Enrollment

TABLE OF CONTENTS

Eligibility to Enroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Medical Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Prescription Drug Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Savings Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Wellness Incentives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Dental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Vision Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 401(k) Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Life, Accidental Death and Dismemberment (AD&D), and Disability Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Voluntary Benefits Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 What You Pay for Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ELIGIBILITY TO ENROLL

Regular employees actively working a minimum of 30 hours per week are eligible to enroll in any of our benefit programs.

You can also choose to cover your legally married spouse. A working spouse surcharge of $100 per month applies if you choose to cover your working spouse with access to their own employer health coverage.

Generally, dependent children are eligible for coverage up to age 26 regardless of student or marital status. Age limitations for some insurance coverage may apply.

For new employees, elections can be made from day 15 until 15 days after the effective date of the benefits. Benefits are effective on the 1st of the month after 60 days of employment.

Current employees can change coverage during open enrollment. Per IRS rules you can't change coverage during the year unless you experience a qualifying life event like getting married or having a baby. You have 30 days from that event to make your change mid-year.

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MEDICAL BENEFITS

Brock offers four health plan options through BlueCross BlueShield of Texas (BCBSTX). Visit for information about the services covered under each plan.

Plan 1 HDHP PPO With HSA

Annual Deductible Individual Family*

In-Network Out-of-Network

$2,700 $5,400

$5,200 $10,400

Annual Out-of-Pocket Maximum**

Individual (employee-only)

$6,450

Family (any other coverage tier)

$12,900

$12,900 $25,800

What You Pay for Covered Services

Preventive Care

$0

Virtual Visits

Office Visit--Primary Care Physician

30% after deductible

30% after deductible

50% after deductible

Not covered

50% after deductible

Office Visit--Specialist Urgent Care Emergency Room

30% after deductible

30% after deductible

50% after deductible

50% after deductible

30% after deductible

Hospital yy Inpatient

yy Outpatient

30% after deductible

50% after deductible

Plan 2 $1,500 EPO In-Network

$1,500 $3,000

$6,450

$12,900

$0

$5 copay

$25 copay

$40 copay

$50 copay $200 copay plus 30% after deductible 30% after deductible

Plan 3 $750 PPO

In-Network Out-of-Network

Plan 4 $6,500 HDHP PPO with HSA

In-Network Out-of-Network

$750 $1,500

$1,500 $3,000

$6,500 $13,000

$13,000 $26,000

$6,450 $12,900

$12,900 $25,800

$6,500 $13,000

$19,500 $39,000

$0 $5 copay

50% after deductible

Not covered

$25 copay $40 copay $50 copay

50% after deductible

50% after deductible

50% after deductible

$200 copay plus 30% after deductible

30% after deductible

50% after deductible

$0

0% after deductible

0% after deductible

0% after deductible 0% after deductible

50% after deductible

Not covered

50% after deductible

50% after deductible 50% after deductible

0% after deductible

0% after deductible

50% after deductible

* Family deductibles are embedded, meaning there is an annual deductible for each covered person. ** Annual out-of-pocket maximum applies to medical and prescription drug expenses combined.

Livongo Diabetes Program through BCBSTX

Brock is partnering with Livongo to offer employees access to tools and resources to better manage their diabetes. The following support is offered through Livongo.

zz Cellularly-enabled blood glucose meters zz Real-time data with personalized data and educational content zz Unlimited support from personal coaches and live interactions

triggered by alerts

zz Free and unlimited supplies shipped directly to your home

zz Livongo will determine, based on employees enrolled in a Brock health plan, if you are eligible to participate. They will reach out to you and give you the opportunity to voluntarily participate.

Plan premiums can be found at the end of this guide in the "What You Pay for Coverage" section. You can also visit for more information.

Brock

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2019?2020 Benefits Enrollment

PRESCRIPTION DRUG BENEFITS

Your medical coverage includes prescription drug benefits through BlueCross BlueShield of Texas.

Plan 1

HDHP PPO With HSA

In-Network

Out-of-Network

Prescription Drugs Retail--30-Day Supply

Preventive

$0

Not covered

Generic

20%, Maximum of $150 after deductible

Not covered

Brand Formulary

30%, Maximum of $150 after deductible

Not covered

Brand NonFormulary

45%, Maximum of $150 after deductible

Not covered

Specialty Drugs

30%, Maximum of $150 after deductible

Not covered

Prescription Drugs Mail Order--90-Day Supply

Preventive

$0

Not covered

Generic

Brand Formulary

Brand NonFormulary

20%, Maximum of $450 after deductible

30%, Maximum of $450 after deductible

45%, Maximum of $450 after deductible

Not covered Not covered Not covered

Plan 2 $1,500 EPO In-Network

$0 20%, Maximum

of $150 30%, Maximum

of $150 45%, Maximum

of $150 30%, Maximum

of $150

$0 20%, Maximum

of $450 30%, Maximum

of $450 45%, Maximum

of $450

Plan 3 $750 PPO

In-Network Out-of-Network

$0

20%, Maximum of $150

30%, Maximum of $150

45%, Maximum of $150

30%, Maximum of $150

Not covered Not covered Not covered Not covered Not covered

$0

20%, Maximum of $450

30%, Maximum of $450

45%, Maximum of $450

Not covered Not covered Not covered Not covered

Plan 4 $6,500 HDHP PPO with HSA In-Network Out-of-Network

$0

0% after deductible

0% after deductible

0% after deductible

0% after deductible

Not covered Not covered Not covered Not covered Not covered

$0

0% after deductible 0% after deductible 0% after deductible

Not covered Not covered Not covered Not covered

Important Note About Your Prescription Drug Coverage

In Plan 1 and Plan 4, you must meet the deductible first before the plans begin sharing in the cost of your prescription drugs. In Plan 1, you will pay a percentage of the cost, called coinsurance, after you meet your deductible. In Plan 4, your prescriptions are 100% covered after you meet your deductible.

Find a BCBSTX Doctor or Hospital

Before you enroll, call Health Advocate at 866.799.2691 to confirm in-network and out-of-network coverage in our plan.

New ID cards will be issued if you're enrolling in any of Brock's medical plans for the first time or if you are reenrolling in Plan 2 or 3. Your health plan or network will be shown on the front of your ID card. If you have questions about which network you have, call the Customer Service number on the back of your card. To see the most accurate list of providers, register or log in to Blue Access for Members at .

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SAVINGS ACCOUNTS

We partner with HSA Bank for our Health Savings Account. Through HSA Bank and Brock's benefits program, you can lower your taxable income and budget for certain expenses by participating in the tax savings accounts. This is a brief summary, for more comprehensive program details visit .

Account

Health Savings Account Healthcare Flexible

(HSA)

Spending Account (FSA)

Overview

Contribute Tax-Free Savings

Use your Visa HSA debit card to pay for eligible medical, prescription drug, dental, and vision out-of-pocket expenses or reimburse yourself from the account as

needed.

$3,500 for individuals $7,000 for families

Use your Visa FSA debit card to pay for eligible medical, prescription drug, dental, and vision out-of-pocket expenses or reimburse yourself from the account as

needed.

$2,700

Dependent Care Flexible Spending Account (DCFSA) Use your Visa debit card to pay for eligible dependent care expenses or reimburse yourself from the account as needed.

$5,000*

* $2,500 if married and filing separately

You must enroll in Plan 1 or Plan 4 to participate in the HSA program. You do not have to elect medical coverage to participate in the FSA programs but if you enroll in Plan 1 or Plan 4, you cannot participate in the Healthcare FSA.

Submitting FSA Claims

All FSA claims need to be submitted through HSA Bank with the exception of medical plan copays (these will be substantiated automatically).

WELLNESS INCENTIVES

The Brock Well-Being Program, powered by Health Advocate, provides you with tools to help you achieve personal health goals and earn a 2020 medical premium credit. You can earn a 2020 medical premium credit of up to $600 for individual and $1,200 for employee and spouse (if both members participate) when you complete well-being activities. Beginning January 1, 2019, you can start working on earning the 2020 incentives.

Health trackers

Workshops

Challenges

Preventive screening

Virtual Visits with MDLIVE!

Virtual visits gives you access to doctors anytime, anywhere by phone, secure video, or mobile app. If you need a prescription, your MDLIVE doctor can send it to your local pharmacy.

MDLIVE treats non-emergency conditions such as the following.

zz Allergies zz Cold/flu zz Ear problems (age 12+)

zz Fever (age 3+) zz Nausea zz Pink eye

zz Rash zz And more!

To activate your account, visit bcbstx, call 888.680.8646, or download the MDLIVE app from Apple's App StoreSM or Google PlayTM.

Personal health profile

View your incentive guide and get started today! Download the Health Advocate app or call 866.799.2691. The well-being incentive is available to eligible employees and their spouses enrolled in a Brock Group medical plan.

Brock

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